A 24 hours duty in a tertiary maternity hospital can be nothing short of walking on a tight rope …

On 2 -11-2020 @ 2 P.M they gave me in handover ….

1. A thrombocytopenia case , a Primi with ITP ( Idiopathic thrombocytopenia Purpura ) her platelet count was 60,000 only…which means high risk of bleeding ) who has to be delivered normally at any cost in order to avoid more blood loss during C- Section. We had kept Donor platelets ( SDP ) ready and in case she needs a C- Section or if she bleeds after delivery .
   
2. Primi with 24 weeks gestation with imminent eclampsia with HELLP syndrome , platelets 60,000 and renal failure ( AKI , all renal parameters elevated 3 times ) and blurring of vision …her pregnancy being terminated to save her from unwanted effects of severe hypertensive disorder in pregnancy .
   
3. An unmarried 18 yr old girl with menorrhagia and Severe Anaemia ( Hb 4 gm ), who needed blood transfusion.
   
4. 4 Emergency Caesrean deliveries to be done and as usual many others in early labour .
   
5. As we started doing these C -Sections , there was a call from Labour Room , it was a PPH … a Multi gravida , G6 who just delivered and had atonic PPH ,meaning uterus fails to retract after delivery causing severe bleeding, we tried all possible measures to control bleeding , bimanual uterine compression , Oxytocics and IV fluids.
   
   No response , we placed a BAKRI Balloon , bleeding was finally controlled . Sigh …what a relief !
   
   That flabby uterus showed mercy on us … all through the process as her Blood Pressure was dropping with loss of every drop of blood , our Blood Pressure started rising… you can imagine the enormous stress we go through here ,just in case of a bad outcome in such cases .
   She lost about 1500 mL blood and needed blood transfusion .Her attender was called to brief her about what was happening and to take high risk consent … she happens to be one of our staff ( Daya) and she was smiling in a casual way as we were explaining the condition to her . It was really disheartening to see how people really do not understand how serious it is when women bleed a lot during delivery. They keep having children endlessly …

10 P.M …there comes another multi …4th Gravida with 3 Previous Caesreans and draining liquor now , we had to open her with a high risk consent for intraabdominal adhesions ( in view of 3 previous surgeries) , risk of visceral injury , bleeding , hysterectomy , need for blood transfusion and other possible post operative complications. As expected uterus was densely adherent to abdominal wall and we struggled to get access to the uterus , fortunately the surgery went well without any complications .

Few more women who had Previous Caesarean delivery had come in labour , we had to continue doing cases all through the night …no rest , no sleep !

And suddenly there was another PPH , this time traumatic one , because of precipitate labour in a Primigravida , because her labour was induced ! Cervix was explored and a deep tear was found which was sutured . She lost nearly 1500 ml blood and we gave her blood transfusion.

@ 1 A.M All of us exhausted physically and mentally , there was another case of abruption , G3 P1 L0A1 with 24 weeks with Previous Caesarean , referred from Devarakonda with complaints of bleeding per vaginum since 4 hours , clothes soaked in blood, Hb 4.5gm ,we needed to deliver her somehow within 2 hours , because when there is abruption of placenta ( premature separation of placenta before delivery ) , the woman needs to deliver within 6 hours otherwise she will go into shock and DIC , blood coagulation defects can occur ,causing multiple organ failure. I gathered enough courage and gave her Misoprostol 50 micrograms ( she is a case of Previous Caesarean … her risk of uterine rupture needs to be balanced against the risk of surgery at this point of time )

… she fortunately expelled the dead foetus of 24 weeks . She received 2 packed cell transfusion too.

2 A.M in the night ,a G3 P2 L2 with 9 weeks gestation, bleeding profusely , because of incomplete abortion , she was dead pale , Hb 4.2 gm , AB negative blood , not available anywhere in the city in that night , not even O negative could be found in any of the blood banks !

3 A.M : An unbooked woman from Orissa , G3 P2 L0 …no live children, delivery gets complicated because of Shoulder dystocia , baby 3.9 kg 😱

4 A.M …A woman with triplets and 35 weeks comes with draining …, she had a cervical cerclage in situ which was removed .

5 A.M HELLP syndrome Pt with AKI delivers and referral done to Osmania General Hospital as she needs dialysis .
6 A.M More inductions of labour started , as some of the previous inductions end successfully .

7 A.M …A G2 P1L0 with 34 weeks admitted in view of complete placenta praevia ( Type 4 …covering the internal os ) , starts trickling blood and sets into labour …

8:15 A.M ….Another G2 P1 L1 with 39 weeks with previous C – Section comes in labour and we had to post it at 8:45 am

A total of 11 C- Sections , 43 vaginal deliveries , many requiring blood transfusions …

All possible complications of Obstetrics experienced thoroughly …thank God , there were no cases of rupture uterus and rupture ectopic in this duty !!

Child birth is never easy , death can drop in every moment and any moment …

I wonder why people tend to take the whole process for granted …

women’s lives do matter ...

“It took me quite a long time to develop a voice, and now that I have it, I am not going to be silent.” – Madeleine Albright